Provider Demographics
NPI:1285354118
Name:KALLAS, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:KALLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:KALLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6821 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7531
Mailing Address - Country:US
Mailing Address - Phone:630-248-9328
Mailing Address - Fax:
Practice Address - Street 1:2133 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2385
Practice Address - Country:US
Practice Address - Phone:206-432-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor